Bronchial Provocation with Methacholine A Literature Review of Safety
A concern associated with reversed with administration of provocation testing performed
methacholine challenge testing is the albuterol delivered by MDI and serially over an 11-year period. The safety profi le of the test procedure. a spacer. All patients returned to baseline FEV1 was greater than 70% Challenge testing with methacholine
acceptable baseline levels within of predicted in this study. More than
has been performed for well over 30 minutes of administration of the 8000 challenges were performed 30 years. Multiple studies and albuterol. Physician intervention was in children with mild to moderate publications have reviewed the not required in any of the cases. Their
expected protocol for performance, conclusion was that methacholine protocol. Only 0.4% of the patients safety, and interpretation of the challenge testing did not need to be did not return to > 90% of the results. In 1999, the American confi ned to the hospital.
Thoracic Society (ATS) published a Guideline for Methacholine and
Exercise Challenge Testing. This et al. investigated the safety of resulted in large numbers of guideline is currently under revision methacholine challenge testing in a methacholine challenge tests in by a group representing both the ATS
retrospective analysis of 88 patients patients with mild to moderate
and European Respiratory Society with a baseline FEV1 less than 60% airfl ow obstruction (>5000) These (ERS).
Only 4 patients did not return to the test procedure in large-scale
Early studies published by greater than 90% of the baseline epidemiologic studies.
Townly, et al in 1979, found that in FEV1 following administration of a over 1500 patients, there were no poststudy beta-agonist treatment.
initial or delayed severe reactions that
A second poststudy beta-agonist testing has been found to be safe
required hospitalization. Pratter and treatment returned the fi nal four even in patients with a lower FEV1, colleagues reported similar results patients to the baseline FEV1. None testing should be approached and in 1984 in over 1000 completed of the patients suff ered any adverse completed with a standard operating methacholine challenge tests.
events. An earlier study in 1982 by procedure in adherence to the
Another study published in 1993 by Ramsdell and colleagues revealed current standards of care. All testing Pratter and colleagues reported on the safety of methacholine challenge
issues of safety and bronchodilator testing in markedly obstructed approach to testing and the ability to reversibility in a prospective study patients. (baseline FEV1 0.45 to 1.66 L)
of predicted). The authors found Management Program (CAMP) both bronchospasm and symptoms evaluated the safety of methacholine
Crapo RO, Casaburi R, Coates AL, et al. Guidelines for methacholine and exercise challenge testing. Am J Resp Crit Care Med 200; 161(1):309-329.
Wanger, JS, Ikle DN, Irvin CG. Airway responses to a diluent used in the methacholine challenge test. Ann Allergy Asthma Immunol 2001;86:277-282.
Martin RJ, Wanger JS, Irvin CG, et al. Methacholine challenge testing; safety of low starting FEV1. Chest 1997;112:53-56.
Ramsdell JW, Nachtwey F, Moser KM. Bronchial hyperreactivity in chronic obstructive bronchitis. Am Rev Respir Dis 1982; 126:829-32.
ATS Pulmonary Function Laboratory Management and Procedure Manual. Chapter 12. 2005.
Goldstein, MF, Pacana SM, Dvorin DJ, et al. Retrospective analyses of methacholine inhalation challenges. Chest 1994; 105:1082-88.
Pratter, MR, Irwin RS. Usefulness and safety of pharmacologic Bronchoprovocation challenge in evaluating patients with normal spirometric tests who are suspected of having asthma. Chest 1988;93:898-900.
Townley RG, Bewtra AK, Nair NM, et al. Methacholine inhalation challenge studies. J Allergy Clin Immunol 1979; 64:569-74.
Pratter, MR, Irwin RS. The clinical value of pharmacologic bronchoprovocation challenge. Chest 1984; 85:260-65.
10. Pratter MR, Bartter TC, Dubois J. Bronchodilator reversal of bronchospasm and symptoms incurred during methacholine Bronchoprovocation challenge. Documentation of safety and time course. Chest
11. Tashkin, DP, Altose MD, Bleecker, ER, et al. The Lung Health Study: Airway responsivemess to inhaled methacholine in smokers with mild to moderate airfl ow limitation. Am Rev Respir Dis 1992;
12. Tashkin, DP, Altose MD, Connett JE, et al. Methacholine reactivity predicts changes in lung function over time in smokers with early chronic obstructive pulmonary disease. Am Rev Respir Dis 1996;
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